control of communicable disease

1. Dr Norfazilah Ahmad
Department of Community Health
UKM Medical Centre
5th September 2012

2.  Relationship between agent, host and
environment and human in diseases
transmission
 Discuss the principles of disease prevention
 Describe methods of control and prevention
used for communicable diseases
 Definition: diseases
prevention, control, elimination, eradication
, extinction, isolation and quarantine
 Examples

4.  Traditional model of infectious disease
causation.
 Three components: an external agent, a
susceptible host, and an environment that
brings the host and agent together.

5. Epidemiologic triangle and triad (balance beam)
HOST AGENT HOST
ENVIRONMENT
AGENT ENVIRONMENT

6.  AGENT FACTORS
◦ Biological – bacteria, virus, parasites, fungi
◦ Physical – physical forces, heat, radiation, noise
◦ Chemical – contaminants, poisons, drugs, allergens
◦ In general, agents must be present for disease to
occur .

7.  HOST FACTORS
◦ Intrinsic factors that influence an individual’s
exposure, susceptibility, or response to a causative
agent.
◦ Example: age, race, sex, socioeconomic
status, behaviors, nutritional status etc.

8.  ENVIRONMENTAL FACTORS
◦ Extrinsic factors which affect the agent and the
opportunity for exposure.
◦ Example; physical factors such as geology, climate
and physical surroundings; biologic factors such as
insects that transmit the agent; and socioeconomic
factors such as crowding, sanitation, and the
availability of health services.

9. HOST
AGENT Increasing ability in agent to
cause infection in host
ENVIRONMENT
AGENT
Increase susceptible host
HOST in the community
ENVIRONMENT

10. HOST
Changes in environment that cause
agent transmission
AGENT ENVIRONMENT
AGENT
Changes in the environment that
increase the host susceptibility to
the disease
ENVIRONMENT HOST

13. Using Avian flu as an example of the chain of infection;
The pathogen is the H5N1 virus.
The reservoir is wild migratory waterfowl.
The pathogen exits the wild fowl through the faeces.
It is transmitted through direct contact with infected materials.
It enters the susceptible host, in this case, humans, through direct
contact with mucous membranes or through small droplet nuclei.

15. Onset of
Exposure Symptoms
Incubation period
Pathologic
changes Time of diagnosis
Stage of Stage of Stage of Stage of
susceptibility Subclinical Disease Clinical Disease Recovery,
Disability, or
Death
Stages in the natural history of disease

16.  Corresponds to time during which the
etiologic agent is present within the body
but has not yet caused signs or symptoms
 Both infectious and noninfectious diseases
are characterized by subclinical stages of
disease.
 In infectious diseases – incubation period
 In noninfectious diseases – latent period or
induction period

17.  Incubation periods vary considerably according to
agent-disease pairs
 Some diseases have
◦ short incubation periods e.g. cholera 24-48 hour,
◦ intermediate e.g. chickenpox 2-3 weeks
◦ extended e.g. AIDS 10 years
 Latency Period for NCD :
◦ Leukemia due Hiroshima atomic bomb 2-12 years
◦ Occupational associated bladder tumors in GB 5-40 years
 Variability in incubation and latency can be due to
differences in host susceptibility, pathogenicity of
the agent, and dose exposure.

18.  Begins with patient’s first symptoms and
ends with either recovery, disability and
death
 Depending on host factors, access to health
care, and the diagnostic certainty of the
clinician in charge, the lag between the
onset of symptoms and diagnosis may vary
considerably.
 The onset of symptoms - not the time of
diagnosis – marks the beginning of the
clinical stage of disease

19. Infectivity
 refers to the proportion of exposed persons
who become infected.
Pathogenicity
 refers to the proportion of infected persons
who develop clinical disease.
Virulence
 refers to the proportion of persons with
clinical disease who become severely ill or
die.

21.  Disease prevention covers measures not only
to prevent the occurrence of disease, such as
risk factor reduction, but also to arrest its
progress and reduce its consequences once
established

22.  Disease prevention efforts can be classified
according to the stage of disease they are
applied:
◦ Primary prevention
◦ Secondary prevention
◦ Tertiary Prevention

23.  Directed toward the stage of
susceptibility, before the pathogen
establishes itself in the body
 Goals :
◦ to prevent disease from occurring
◦ reducing its incidence and prevalence in the
community
◦ Example: needle exchange programs to prevent the
spread of HIV, vaccination programs, smoking
cessation campaign

24. Stages in the natural
Onset of history of
Exposure Symptoms disease and type of
prevention
Incubation period
Pathologic
changes Time of diagnosis
Stage of Stage of Stage of Stage of
susceptibility Subclinical Disease Clinical Disease Recovery,
Disability, or
Death
Secondary
Prevention: Tertiary
Primary
Intended to Prevention:
Prevention: Level of
reduce Intended to
Intended to
reduce new duration and reduce Prevention
severity complications
occurrences
and disabilities

25.  Directed toward the subclinical
stage, people who carry the agent in their
bodies but are not yet symptomatic
 Goal:
◦ To reduce the expression or severity of the disease
once it emerges.
◦ Example; treating asymptomatic HIV infected pts
with combination of antiviral agents, screening for
cervical cancer and breast cancer to detect the
diseases in their early stages.

26. Stages in the natural
Onset of history of
Exposure Symptoms disease and type of
prevention
Incubation period
Pathologic
changes Time of diagnosis
Stage of Stage of Stage of Stage of
susceptibility Subclinical Disease Clinical Disease Recovery,
Disability, or
Death
Secondary
Prevention: Tertiary
Primary
Intended to Prevention:
Prevention: Level of
reduce Intended to
Intended to
reduce new duration and reduce Prevention
severity complications
occurrences
and disabilities

27.  Directed toward the clinical stage
 Goal :
◦ To prevent or minimize the progression of the
disease or its sequelae
◦ Example; screening people with diabetes for
diabetic retinopathy in order to promptly treat the
progression of blindness

28. Stages in the natural
Onset of history of
Exposure Symptoms disease and type of
prevention
Incubation period
Pathologic
changes Time of diagnosis
Stage of Stage of Stage of Stage of
susceptibility Subclinical Disease Clinical Disease Recovery,
Disability, or
Death
Secondary
Prevention: Tertiary
Primary
Intended to Prevention:
Prevention: Level of
reduce Intended to
Intended to
reduce new duration and reduce Prevention
severity complications
occurrences
and disabilities

30.  Control:
◦ The reduction of disease
incidence, prevalence, morbidity or mortality to a
locally acceptable level as a result of deliberate
efforts;
◦ Continuous intervention measures are required to
maintain the reduction.
◦ Example: diarrhoeal diseases.

31.  Isolation
◦ In epidemiology isolation refers to a procedure
used in communicable disease control. It consists
of a separation of cases (persons or animals) for
a disease's period of communicability.
◦ The cases are isolated in a specific location and
under conditions that minimize the risk of direct
or indirect transmission of the infectious agents
to those who may be susceptible

32.  Quarantine
◦ Quarantine is defined as a restriction of the
activities of healthy persons or animals who have
been exposed to a communicable disease.
◦ The aim is to prevent transmission of the disease
from potentially infected persons to healthy
persons during the incubation period.
◦ Quarantine can take two forms:
 absolute or complete quarantine, which consists of a
limitation of freedom for a period equal to the longest
usual incubation period of the disease;
 modified quarantine, which involves selective or partial
limitation of movement, based on known differences in
susceptibility.

33.  Elimination of disease:
◦ Reduction to zero of the incidence of a specified disease in
a defined geographical area as a result of deliberate efforts;
continued intervention measures are required. Example:
neonatal tetanus.
 Elimination of infections:
◦ Reduction to zero of the incidence of infection caused by a
specific agent in a defined geographical area as a result of
deliberate efforts; continued measures to prevent re-
establishment of transmission are required. Example:
measles, poliomyelitis.
 Eradication:
◦ Permanent reduction to zero of the worldwide incidence of
infection caused by a specific agent as a result of deliberate
efforts; intervention measures are no longer needed.
Example: smallpox.

34.  Extinction:
◦ The specific infectious agent no longer exists in
nature or in the laboratory.

35.  Endemic - means a disease occurs continuously
and with predictable regularity in a specific area or
population .
 Epidemic - a widespread outbreak of an infectious
disease where many people are infected at the
same time.
 Outbreak - an epidemic limited to localized
increase in the incidence of a disease, e.g., in a
village, town, or closed institution
 Pandemic - an epidemic occurring worldwide, or
over a very wide area, crossing international
boundaries, and usually affecting a large number
of people.

36. Cholera (V. cholerae)
 Primary prevention
◦ Health education
◦ Management of water supply, sanitation and food
hygiene
◦ Vaccine?
 Secondary prevention
◦ Early detection and treatment (ORS and antibiotic)
 Tertiary prevention
◦ Rehabilitation

37. Dengue fever
 Primary prevention
◦ Health education
◦ Environment sanitation, human behaviour
◦ Mosquitoe net, bed nets,Vaccine?
 Secondary prevention
◦ Early detection and treatment
◦ Isolation or quarantine?
 Tertiary prevention
◦ Prevent/reduce complication
◦ rehabilitation

38. •Host immunity
•Vaccine?
Dengue Prevention using the •Protective Behaviour
agent, host, environment model
Host
Agent Environment
•Dengue serotype •Aedes breeding
•Sanitation
•Community behaviour
•Climate

39. Prevention and
Control Of
Communicable
Disease